Anti‐obesity medications and incident ocular outcomes: A systematic review and network meta‐analysis

Abstract

The widespread use of anti‐obesity medications (AOMs), particularly incretin‐based therapies, has raised questions regarding their ocular safety. We conducted a systematic review and network meta‐analysis following PRISMA guidelines to evaluate associations between AOMs and prespecified ocular outcomes, including overall ocular outcomes, DR, NAION, macular diseases, cataract, glaucoma, and blurred vision. PubMed, Embase, Web of Science, and CENTRAL were searched from inception to January 6, 2026. A total of 140 studies (69 randomized controlled trials and 71 observational studies) were included, covering glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs), dual/multi‐agonists, and older AOMs.

Randomized evidence identified no significant associations between any AOM and incident ocular outcomes or DR. Observational evidence revealed substantial heterogeneity in ocular safety profiles. GLP‐1 RA use was associated with an increased risk of NAION (HR 1.71, 95% CI 1.33–2.20), with preliminary evidence of stronger associations among older adults and men, but not with overall ocular outcomes (HR 0.96, 95% CI 0.86–1.08). Dual/multi‐agonists were associated with a lower risk of overall ocular outcomes than GLP‐1 RAs (HR 0.52, 95% CI 0.34–0.79). GLP‐1 RAs were associated with a reduced risk of glaucoma (HR 0.66, 95% CI 0.58–0.76), particularly in women and severe obesity. No clear associations were observed for macular diseases or cataract.

These findings provide the most comprehensive synthesis to date of ocular outcomes associated with contemporary AOMs and support stratified risk assessment in clinical decision‐making. Prospective ophthalmic surveillance and mechanistic studies are warranted to validate these signals and elucidate biological mechanisms underlying drug‐specific ocular effects.